Thank you for participating in The Mycotoxins and Chronic Illness Summit. Please complete this form to access your interview booking link.
Participation in the summit will include electronic recording of the Guest/Speaker presentation and interview with Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND. Guest/Speaker understands that for educational, promotional, and commercial applications, Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND will make Speaker’s presentation/interview video recording available at no charge to summit registrants.
1) Guest/Speaker hereby grants to Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND the right to use his or her name, voice, appearance, likeness, image, words, participation, and title or professional designation, in whole or part, in these recordings and/or compilations and in any correspondence, publicity, advertising, promotional, or other derivative materials based on them. Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND have no obligation to make use of the rights granted herein.
2) Guest/Speaker hereby grants Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND the unconditional and irrevocable right to reproduce the Recording in any format, and to distribute, sell, prepare derivative works, advertise, and publicize the Recordings without compensation to Guest/Speaker. Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND may edit the Recordings at their discretion. Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND shall own the worldwide rights, title, and interest, including copyright in, and to, the Guest/Speaker’s Recording. However, Guest/Speaker shall also retain the right to use his or her own Recording for any purpose.
3) Guest/Speaker, upon written request to Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND, shall be provided with a copy of his or her interview in the form of the MP3 audio file and interview transcript.
4) Guest/Speaker agrees to send a minimum of 2 (two) solo emails to their whole database during the agreed-upon promotion period. The Guest/Speaker also agrees to make at least 1 (one) promotional post on all available social media outlets during the promotional period.
5) Guest/Speaker is permitted to make a FREE offer during his or her presentation/interview including the provision of a URL or other traffic destination.
6) Guest/Speaker represents that he or she has the full right, power, and authority to grant this release and to perform all of the provisions thereof. Guest/Speaker acknowledges that in the event of a breach or alleged breach with respect to the terms and provisions hereof, that Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND shall be entitled to such injunctive or equitable relief as Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND may deem appropriate, in addition to such other rights or remedies Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND may have at law.
7) Guest/Speaker agrees to indemnify and hold harmless Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND from and against all claims, losses, expenses, and liabilities of every kind including reasonable attorney’s fees arising out of the Inaccuracy or breach of any provision of this Agreement. Guest/Speaker expressly releases Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND from any and all claims arising out of the use of the material.
8) This release shall be governed in accordance with the State of Washington, and constitutes the entire agreement of the parties, and may be amended only in writing.
By completing and submitting this form, you confirm understanding and agreement to all terms and conditions stated above and confirm the accuracy of the information provided.
I agree to the Speaker Agreement. I confirm that I will perform all promotional activities stated in point 4 listed above. I am also agreeing to be an Affiliate for the The Mycotoxins and Chronic Illness Summit.
Your Contact Email Address
PayPal Email Address (Commission payment will be sent to this email address)
Your Primary Website URL
Upload Your Preferred Headshot (minimum 400x400 pixels)
Max. file size: 50 MB.
Your Bio (How you want to be introduced during the interview)
Assistant/Point Of Contact Name
Assistant/POC Contact Number
List Size (Example: 1,500 or 16k. This information will help us estimate the number of summit attendees.)
Affiliate Signup URL:
Please enter the link here for us to sign up as a reciprocal affiliate
MM slash DD slash YYYY
Please provide your proposed talk title:
Please provide 3 to 5 bullets describing key points you will be covering in your talk.
Please provide 5 interview guide questions. Please be advised that these questions may or may not be used during the interview. Discretion will be made by Dr. Eric Gordon, M.D. and Dr. Nafysa Parpia, ND. Interview Question #1
Interview Question #2
Interview Question #3
Interview Question #4
Interview Question #5
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